Staphylococcal scalded-skin syndrome in an adult due to methicillin-resistant Staphylococcus aureus. 2002

Yoichiro Ito, and Miyuki Funabashi Yoh, and Katsuhisa Toda, and Makoto Shimazaki, and Toshiyuki Nakamura, and Eri Morita
Department of Internal Medicine, Gifu Red Cross Hospital, 3-36 Iwakura-cho, Gifu 502-8511, Japan. gifu-med@gifu.email.ne.jp

We report a case of a 71-year-old man with staphylococcal scalded-skin syndrome (SSSS). The patient, with a chronic history of diabetes mellitus, was admitted to our hospital with lumbago, and a diagnosis of renal-cell carcinoma with bone metastasis was made. In hospital he had sudden onset of high fever and erythema, followed by the formation of flaccid bullae and exfoliation, with a positive Nikolsky sign. Methicillin-resistant Staphylococcus aureus (MRSA), producing exfoliative toxin B, was isolated from blood and bile cultures, and Aeromonas hydrophila was isolated from bile culture. Skin biopsy specimen showed a cleavage of the epidermis at the level of the granular layer. The patient was diagnosed as having SSSS and cholecystitis, and was treated with intravenous antibiotics and percutaneous transhepatic gallbladder drainage, which led to recovery. SSSS in adults is usually associated with immunosuppression. A. hydrophila is recognized as an opportunistic pathogen. SSSS should be considered in the differential diagnosis of immunocompromised adult patients with sudden onset of high fever and erythema.

UI MeSH Term Description Entries
D008297 Male Males
D003937 Diagnosis, Differential Determination of which one of two or more diseases or conditions a patient is suffering from by systematically comparing and contrasting results of diagnostic measures. Diagnoses, Differential,Differential Diagnoses,Differential Diagnosis
D005083 Exfoliatins Protein exotoxins from Staphylococcus aureus, phage type II, which cause epidermal necrolysis. They are proteins with a molecular weight of 26,000 to 32,000. They cause a condition variously called scaled skin, Lyell or Ritter syndrome, epidermal exfoliative disease, toxic epidermal necrolysis, etc. Dermolysins,Epidermolysins,Epidermolytic Toxins,Exfoliative Toxins,Exfoliatin Toxin A,Exfoliative Toxin B,Staphylococcal Exfoliative Toxin,Exfoliative Toxin, Staphylococcal,Toxin A, Exfoliatin,Toxin B, Exfoliative,Toxin, Staphylococcal Exfoliative,Toxins, Epidermolytic,Toxins, Exfoliative
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D013206 Staphylococcal Scalded Skin Syndrome A disease of infants due to group 2 phage type 17 staphylococci that produce an epidermolytic exotoxin. Superficial fine vesicles and bullae form and rupture easily, resulting in loss of large sheets of epidermis. Ritter Disease,Scalded Skin Syndrome, Staphylococcal,Ritter's Disease,Staphylococcal Scalded-Skin Syndrome,Disease, Ritter,Disease, Ritter's,Ritters Disease,Scalded-Skin Syndrome, Staphylococcal,Scalded-Skin Syndromes, Staphylococcal,Staphylococcal Scalded-Skin Syndromes,Syndrome, Staphylococcal Scalded-Skin,Syndromes, Staphylococcal Scalded-Skin
D013211 Staphylococcus aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications.
D016106 Methicillin Resistance Non-susceptibility of a microbe to the action of METHICILLIN, a semi-synthetic penicillin derivative. Methicillin-Resistant,Methicillin Resistant,Resistance, Methicillin
D016980 Aeromonas hydrophila A species of gram-negative, facultatively anaerobic, rod-shaped bacteria that may be pathogenic for frogs, fish, and mammals, including man. In humans, cellulitis and diarrhea can result from infection with this organism.

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